Академический Документы
Профессиональный Документы
Культура Документы
General Data
D.A
21 years old
Male
Single
Catholic
Tabangao, Ambulong, Batangas City
Admitted on December 15, 2013
Chief Complaint
Rashes
5 days PTA
Loss of appetite
Post prandial pain
Throat pain
Generalized body weakness
No consult done
Continue self medication
2 days PTA
Rashes, pruritic
Cough, productive, yellowish phlegm
Few hours PTA
Rashes progressively spread all over his body
Difficulty of breathing
Family History
(-) HTN, DM
3-4 sticks/day
Review of System
General: (-) weight loss, (-) weight gain, (-)chill, (-)
(-) dryness
Respiratory: (-) cough, (-) chest, (-) dyspnea
Cardiac: (-) orthopnea, (-) PND, (-) palpitation
Nervous: (-)dizziness, (-) seizures
Extremities: (-) pain, (-) weakness, (-) tenderness,
(-) cramps
Physical Examination
General Survey: The patient is conscious, coherent,
Neurological Exam
Cerebral Function: awake, alert, oriented to time,
Admitting Impression
Measles
Admission: ER
IVF: D5LR 1L x 40 gtts/ min
Medications:
Paracetamol 500mg/tab q4 prn for fever
Loratadine 10mg/tab OD
Metoclopramide 10mg/IV q8 prn for vomiting
Omeprazole 40mg/IV OD
Ceftriaxone 2g/IV OD ( ) ANST
Azithromycin 500mg/tab OD
Salbutamol + Ipratropium Bromide neb q8
Vital signs every 4 hours
Laboratory Findings
CBC
12/15/13
Erythrocytes
5.27
Hemoglobin
168.2
Hematocrit
0.465
Leukocyte
6.34
Neutrophil
0.655
Eosinophil
0.005
Basophils
0.047
Lymphocytes 0.158
Monocytes
0.047
Thrombocytes
132
MCH
31.93
MCV
31.93
MCHC
0.36
RDW
111
MPV
Blood typing
O positive
U/A
Color Speci pH
fic
Gravi
ty
Suga
r
Albu
min
Pus
Cells
RBC
Amo
rp
Urat
es
Amb
er
(-)
(-)
2-4
1-2
Mode Few
rate
1.025 6
Epith
cells
Bacte
ria
Few
Blood Chemistry
12/15/13
Sodium
121
Potassium
3.06
BUN
11.5
Creatinine
94.8
Chest Xray
Basal
Pneumonia,
Left
Potasium: 3.06
Home Meds:
Cefixime 200mg/tab BID x 7days
Azithromycin 500mg/tabs OD x 3 days
Salbutamol + Ipratropium Bromide neb every 8 hours
Loratadine 10mg/tab OD as needed
Measles
Definition
highly contagious viral disease that is characterized
Etiology
spherical, nonsegmented, single-stranded, negative-
Epidemiology
most highly contagious directly transmitted
pathogens
common among household contacts, school-age
children, and health care workers
Endemic measles has a typical temporal pattern.
As measles vaccine coverage increases or population
density decreases
Persons with measles are infectious for several days
before and after the onset of rash.
Pathophysiology
Transmission
Respiratory droplets
Small-particle aerosols
Airborne transmission
Direct contact with infected secretions
Incubation Period
10 days to fever onset
14 days to rash onset
Adults up to 3 weeks
Clinical Manifestations
Kopliks spots
pathognomonic of
measles
bluish white dots 1 mm in
diameter surrounded by
erythema
buccal mucosa opposite
the lower molars but
rapidly increase in
number to involve the
entire buccal mucosa
Rash
erythematous macules
extremities
behind the ears and on petechiae may be present
the neck and hairline
The rash fades slowly progresses to involve the usually beginning on the
face, trunk, and arms
third or fourth day after
with involvement of the
onset
legs and feet by the end Resolution of the rash
of the second day
may be followed by
Areas of confluent rash
desquamation
appear on the trunk and
Differential Diagnosis
Rubella
Kawasaki disease
Infectious mononucleosis
Roseola
Scarlet fever
Rocky Mountain spotted fever
Enterovirus
Adenovirus infection
Drug sensitivity
Laboratory Diagnosis
Serology
Culture
PCR
Treatment
No specific antiviral
therapy
Supportive measures
Hydration
Antipyretic therapy
Antibiotic therapy
Pneumonia; Otitis Media
Vitamin A
>12 months of age - oncedaily doses of 200,000 IU of
vitamin A for 2 consecutive
days
6-12 months of age -100,000
IU per day
<6 months of age - 50,000
IU per day
third dose is recommended
24 weeks later for children
with evidence of vitamin A
deficiency
Complications
Most common
Otitis Media
Bronchopneumonia
Respiratory Tract
Acute laryngotracheobronchitis
Giant-cell pneumonitis
Central Nervous System
Encephalomyelitis
Measles inclusion body encephalitis
Subacute sclerosing panencephalitis
Prevention
Passive Immunization
Human immunoglobulin
within 72 h of exposure - immunocompetent persons
Administered up to 6 days after exposure
Prophylaxis - children <1 year of age, immunocompromised
persons and pregnant women
0.25 mL/kg given intramuscularly
Immunocompromised - 0.5 mL/kg.
maximum total dose - 15 mL
IV immunoglobulin usual dose of 100400 mg/kg
prophylaxis for measles exposures occurring as long as 3 weeks
or more after IV immunoglobulin administration
Active Immunization
Mumps and rubella (MMR)
Mumps, rubella, and varicella (MMR-V)
first vaccination varies from 6 to 15 months
THANK YOU!